She Suffered Stability Points for Years. Was It a Mind Tumor?

But when he saw the dental CT, he immediately ordered a conventional CT of her head. The dental scan is designed to get a three-dimensional image of the jaw and teeth so it cannot be expected to show the entire skull. Full CT confirmed that there was a small mass in the left sinus. Based on her appearance, her doctor suspected it was a remnant of an infection from the years before. But on the right side was something else: a mass the size of a strawberry had destroyed much of the mastoid bone just behind her ear. It was in the same location as the much smaller abnormality seen in the first few years of MRI. Now it was big enough to compress one of the vessels that led to the jugular vein. The radiologist said it looked like an infection. Or possibly a rare type of bone cancer.

Since cancer was possible, the patient decided she needed a second opinion. She reached out to the Mayo Clinic’s Arizona office in Phoenix, and two weeks later she was supposed to be Dr. Visit Peter Weisskopf. Weisskopf listened as the patient described the dizziness, tinnitus, and hearing loss, as well as debilitating fatigue and the terrible feeling of impending doom. “I’m not sure this mass could be causing all of this,” he said, but he agreed that an MRI would provide important diagnostic information. He suspected that she had something known as a cholesteatoma. These are benign cell growths that become trapped in the ear – or rarely, as in this patient’s case – in the brain and begin to grow. Sometimes these cells are imported into the ear after a chronic infection, but most of the time they stay there during the development of the fetus.

Weisskopf checked the MRI. As expected, the brain tissue showed up as light and dark gray stripes, surrounded by fluid that appears black. But just behind this patient’s ear, embedded in the lower edge of the mastoid bone of the skull, was a large bright white cloud. Because of this appearance, Weisskopf knew what she had. It was a cholesteatoma. Although this is not a cancer, these types of tumors need to be removed. If they stay in place, they will continue to enlarge until they cause real problems. The patient really wanted to have the thing removed. She was sure that it must be behind the symptoms she had been living with over the years.

Removing the bulk required two surgeries, the second late last spring. But it was worth it, the patient told me. The worst symptoms have completely disappeared. Her tiredness and feelings of oppression and doom disappeared after the first operation. But even after the second she still has the tinnitus, which is sometimes very loud. She still has problems with her balance. Your hearing is not as good as it used to be.

Weisskopf does not believe that the mass caused the patient’s symptoms. The patient respectfully disagrees; Where it really matters, with her mood, her well-being, she feels back to something like her old self. And while her doctor can’t make the connection, she’s sure it all came from this growth, which she thought might not have been quite as harmless as her doctors and textbooks say.

Lisa Sanders, MD is a contributing writer for the magazine. Her latest book is Diagnosis: Solving the Most Confusing Medical Mysteries. When you have a resolved case you like Dr. To tell Sanders, write to Lisa at .Sandersmd @ gmail.com.